Tolerance of peripheral nerve to intraoperative radiotherapy (IORT): Clinical and experimental studies

Timothy J. Kinsella, William F. Sindelar, Anne Marie DeLuca, G. Pezeshkpour, Rosalie Smith, Michelle Maher, Richard Terrill, Robert Miller, Arnold Mixon, James F. Harwell, Steven A. Rosenberg, Eli Glatstein

Research output: Contribution to journalArticlepeer-review

105 Scopus citations


In our clinical experience combining wide excision and intraoperative radiotherapy (IORT), five patients have developed clinical signs of lumbosacral or sciatic neuropathy within 9 months of receiving IORT to a dose of 20-25 Gy. Three patients showed recovery of nerve function over several months while two patients have shown no recovery and have near complete loss of extremity function. In an attempt to investigate this clinical observation further, the lumbosacral plexus and sciatic nerve of American foxhounds were surgically exposed and received a single dose of IORT ranging from 20-75 Gy. An approximate linear relationship between radiation dose and time to onset of hind limb paresis is found with 19 of 21 irradiated dogs showing clinical signs of nerve injury within an interval of 1-19 months. No recovery of nerve function is seen in these dogs. Histological study of the irradiated nerves demonstrates a loss of nerve fibers, particularly those of the large myelinated type without evidence of vascular occlusion or thrombosis. These studies suggest that peripheral nerve may be a dose-limiting normal tissue in clinical studies of IORT.

Original languageEnglish (US)
Pages (from-to)1579-1585
Number of pages7
JournalInternational journal of radiation oncology, biology, physics
Issue number9
StatePublished - Sep 1985


  • Intraoperative radiotherapy
  • Peripheral nerve injury

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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